Geriatric Medicine

300 Specialty Certificate Exam Questions

Shibley Rahman, Henry J. Woodford

• Publisher: CRC Press
• Year: 2021
• ISBN:
  9781000422429
• Edition: 1
• Topic: Médecine
• Subtopic: Gériatrie

This book is an authoritative and well-structured text which is both topic and curriculum oriented, aimed to appeal to a wider multi-professional audience in line with the current NHS workforce training needs in the UK. It is based on the 'specialist certificate examination' (SCE), awarded for the completion of higher specialist training. Following closely the published blueprint from the Royal College of Physicians, and the curriculum from JRCPTB, it provides an up-to-date bank of revision material. These 300 questions in the 'single best answer' (SBA) format (like the actual assessment), are complete with comprehensive, well-evidenced explanations and explanatory further reading material.

Key Features

• Maps the entire curriculum covered on the geriatric specialization exam

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• Addresses the gap in the market to educate on the core curriculum for the busy professionals and post graduate medical trainees working towards this examination

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• The book is thematically organized to make it an accessible quick reference for also those not planning to take the exam but seeking to broaden and deepen their own knowledge base

1
Acute Illness (Diagnosis and Management)

LEARNING OBJECTIVE:

To be able to diagnose and manage acute illness and emergencies, including both medical and surgical conditions, in older patients across a variety of settings.

This might include emergency presentations across diverse conditions, including exacerbations of chronic diseases:

• Anaemia/haematology
• Cardiovascular medicine
• Dermatology
• Endocrine and metabolic medicine (including hypothermia and hyperthermia, neuroleptic malignant syndrome)
• Gastroenterology (including constipation, diarrhoea, faecal impaction)
• Infection and sepsis
• Musculoskeletal medicine (including physical deconditioning)
• Neurology
• Renal medicine (fluid/electrolyte imbalance)
• Respiratory medicine
• Sensory impairment

Other aspects might include:

• Drugs, including compliance, interactions and unwanted effects, in older people.
• Ethical and legal framework for making decisions on behalf of patients who lack mental capacity.
• Secondary complications of acute illness in older people and strategies to prevent them.
• Older people’s physiological management.

Questions

Question 1

An 85-year-old man is admitted from his own home with pneumonia. He has a past history of cerebrovascular disease and vascular dementia. He has poor dental health, bi-basal chest crackles and an impaired swallow. It is suspected that he has developed pneumonia due to aspiration. Which of the following interventions has been shown to lower the risk of aspiration pneumonia in older people?

1. improved oral hygiene
2. percutaneous endoscopic gastrostomy tube feeding
3. physical exercise group activities
4. thickened fluids
5. using newer atypical antipsychotic drugs in preference to older typical ones

Question 2

You see a 92-year-old man acutely admitted to your ward with cellulitis of the left leg. As a coincidental discovery, he was found to have atrial fibrillation on his ECG. You are considering whether to offer him anticoagulation to reduce the risk of future embolic stroke but are cautious due to him having moderate to severe frailty. Which of the following is a component of the HAS-BLED score?

1. heart failure
2. high blood pressure
3. peptic ulcer disease
4. recent head injury
5. surgery within the last three months

Question 3

While on call you are phoned by a GP asking for help with the interpretation of a blood test result for a patient with suspected heart failure. Which of the following scenarios is more likely to result in an elevated serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration?

1. African or African-Caribbean family origin
2. age over 70 years
3. current ACE inhibitor use
4. current beta-blocker use
5. obesity

Question 4

A 73-year-old man has been admitted due to a fall on the background of a general decline in his physical and cognitive function over the last few weeks. His past history includes cerebrovascular disease, vascular dementia and depression. His usual medications are clopidogrel 75 mg od, atorvastatin 40 mg nocte, ramipril 5 mg od and solifenacin 5 mg od. While in hospital he was started on quetiapine for his agitation and mirtazapine for low mood. Over the last 24 hours he has been noted to be drowsier, and is not responding verbally at present. His temperature is 38.1°C, pulse 118 beats per minute and blood pressure 184/97 mmHg. Examination of his chest and abdomen are unremarkable. His pupils are 2 mm bilaterally and reactive to light, tone is increased in all of his limbs and reflexes appear normal. What is the most likely diagnosis?

1. anticholinergic toxicity
2. dementia with Lewy bodies
3. neuroleptic malignant syndrome
4. serotonin syndrome
5. urinary tract infection

Question 5

A 78-year-old woman has been admitted following a fall at home occurring while she was hurrying to get to the toilet during the night. She has a history of watery diarrhoea over the last four weeks, passing loose stools three to six times each day, including overnight. She has had several episodes of associated faecal incontinence. Three days prior to admission, she had a colonoscopy performed, which had not shown any macroscopic abnormalities (biopsy results awaited). Her GP had also sent a stool culture one week ago which had also not detected any abnormality. Blood tests show that she is mildly dehydrated but otherwise normal, including coeliac serology. Her past history includes ischaemic heart disease, hypertension and a cholecystectomy for gallstones. She takes aspirin 75 mg od, simvastatin 40 mg nocte and amlodipine 5 mg od. She normally lives alone and is independent in her personal care. Physical examination is unremarkable. Which investigation or action would be most appropriate to do next?

1. faecal calprotectin test
2. faecal elastase test
3. hydrogen breath test
4. ⁷⁵SeHCAT test
5. start oral budesonide

Question 6

A 71-year-old man presents with urinary incontinence and reduced mobility. Usually he is independently mobile and self-caring. He has a past history of type 2 diabetes and hypertension. He also has a many-year history of chronic back pain, which has been a little worse recently. A bladder scan shows >999 mL of urine within his bladder. His BMI is 35 kg/m² but he reports that he has lost some weight recently. On examination, his abdomen is soft and non-tender but there is fullness supra-pubically. His heart sounds are normal and his chest is clear. Sensation and power appear intact in his lower limbs, but his knee and ankle reflexes are diminished. Which investigation would you do next?

1. CT abdomen and pelvis
2. intravenous urogram
3. MRI spine
4. prostate specific antigen
5. urine culture

Question 7

A 77-year-old man has been admitted to hospital after having been found in a state of reduced responsiveness by his carer. Over the past week he had complained of a cough, and his oral intake had declined. He is found to be drowsy and looks clinically dehydrated. His past medical history includes type 2 diabetes that is controlled with a combination of metformin and twice daily insulin. There is no prior evidence of renal impairment. His observations show pulse 113 beats per minute, blood pressure 88/46 mmHg, respiratory rate 28 per minute, temperature 37.6°C and weight 79 kg.

He is commenced on intravenous antibiotics for pneumonia. In addition to this, which is the best initial treatment for this man?

1. 0.45% sodium chloride 1 L over one hour
2. 0.9% sodium chloride 1 L over one hour
3. 0.45% sodium chloride 1 L over one hour, plus insulin infusion at rate of four units per hour
4. 0.9% sodium chloride 1 L over one hour, plus insulin infusion at rate of four units per hour
5. 0.45% sodium chloride 1 L over one hour, with 40 mmol potassium added, plus insulin infusion at rate of four units per hour

Question 8

An 89-year-old woman is admitted following a fall at home. She is found to have a low blood pressure, with readings of 87/54 while lying down and 83/49 on standing. She has a past history of hypertension and ischaemic heart disease; she has not had any regent angina. Her regular medications are aspirin 75 mg od, amlodipine 5 mg od, atorvastatin 20 mg od, bisoprolol 5 mg od, furosemide 40 mg od and lisinopril 5 mg od. She lives alone and mobilises with a two-wheeled frame indoors. On examination, she has moderate bilateral ankle oedema but no other abnormalities are detected. Her initial blood tests are as below:

Table 1.1 Investigations.

Serum sodium	159 mmol/L (137–144)
Serum potassium	5.2 mmol/L (3.5–4.9)
Random plasma glucose	41 mmol/L (4.0–7.8)
Serum urea	35.3 mmol/L (2.5–7.8)
Serum creatinine	216 µmol/L (64–104)
Serum osmol...